Patients with chronic wounds are cared for by a variety of clinicians during the course of their treatment. Many of these patients seek treatment in different settings including hospitals, nursing homes, and out patient wound centers. Few clinicians have expertise in managing chronic wounds, which is why the wound resolution rate is so low, and the morbidity and mortality so high. A wound related informatics system that is secure and universally accessible by healthcare professionals, regardless of their geographic location, could potentially improve clinical decision making in the management of wounds and, consequently, decrease the morbidity and mortality in more than 3 million patients suffering from pressure ulcers and diabetic foot ulcers. The purpose of this study is to develop and evaluate a HIPAA compliant Wound Electronic Medical Record (WEMR) to determine if it can reduce the progression of early stage pressure ulcers (l-lll) to stage IV, and decrease the rate of amputations associated with diabetic foot ulcers. A longer term goal of this program is to evaluate the utility of the WEMR on an entire healthcare system (including hospitals, nursing homes, and wound centers).
The research hypotheses of this study are: 1) the WEMR will significantly decrease the number of pressure ulcers that progress to stage IV and 2) the WEMR will significantly decrease the number of amputations associated with diabetic foot ulcers.
To accomplish these hypotheses, we have developed the WEMR, which comprises of a photograph of the wound, a real-time graph of the wound's healing rate as measured by area, vascular testing, chemistry, hematology, microbiology laboratory values, current wound treatments, glycemic control, ambulatory status, and radiology and pathology reports. The WEMR has been beta-tested in 1600 consecutive patients in a tertiary care hospital and out patient unit. The preliminary data suggests: 1) that when pressure ulcers are diagnosed before they progress to bone and an appropriate treatment protocol is instituted, they heal; 2) diabetic foot ulcers, in the absence of ischemia and osteomyelitis, heal when they are treated appropriately, thereby averting amputations. The data from beta testing suggests that having all relevant patient information electronically available in one easily accessible record significantly facilitates coordination of clinical care among multiple health care providers, both on the hospital premises and from remote locations. To more definitively test our hypothesis that using the WEMR accelerates wound healing, we propose a multi-site prospective cohort study in 4 institutions: NYU, Cornell, and Southside Hospital as control sites and Columbia as the experimental site. Given that this is a nonrandomized study, the analysis will adjust for patient differences across sites using stratification by propensity scores. We have brought together a team of experts in the fields of wound healing, nursing, medicine, surgery, epidemiology and biostatistics to collaborate on this multi-site study. The proposed study offers a unique opportunity to systematically evaluate a hospital wide electronic medical record system and measure its effects on decreasing the incidence of stage IV pressure ulcers and decreasing amputations associated with diabetic foot ulcers as compared to other centers not using this informatics system.